Essential Nutrients Interactions with Medications
On this page
Essential nutrients interactions with medications pose major problems in treatment plans and may deplete nutrients in the body. We hope to give a hand to colleagues in checking nutritional status with Nutri-IQ in order to holistically prevent, recognize and close nutritional gaps.
Introduction
At all life transitions, it is wise to take nutritional supplements. During childhood, especially for children who do not eat a balanced diet or who consume sugar foods, which deplete body nutrients, an extra daily multivitamin/mineral is a good idea. For elderly people, whose digestive systems are not always working optimally and some of whose nutrient needs may be increased, especially for such minerals as calcium, magnesium, and potassium, extra supplementation may help with continued vitality and health.
Due to enormous leap ahead of medical science, success of main-stream pharmaceuticals (and we hope, equally nutraceuticals) we do live longer. Provided we dutifully take prescribed medication. However, supplementation is regarded as a bio-hack en mass. Which means people are buying and using supplements increasingly, without really giving a second thought. In 2017, the North American nutraceuticals market was approximately the same size as beer market ($36.1 billion vs $37 billion), but is expected to be worth $126 billion by 2022 exceeding beer sales almost 4 times!
Here comes the risk! Nutraceuticals are not always formulated keeping in mind a slew of medical conditions the potential user can suffer and medications he takes to deal with them. In this article, we hope to give a hand to our colleagues and shed some light on possible supplement-medication interactions as essential nutrients can interact with certain medications, and some medications can have an adverse effect on essential nutrient levels.
Wellness professionals have to ensure that individuals taking medications on a regular basis discuss affected vitamin/nutrient status with their healthcare providers.
Assessment of nutritional balance brings cost-effective immediate answers when your client:
- Feels stressed, tired, depressed
- Takes prescription meds but cannot alleviate symptoms
- Wants to achieve optimal wellness, prevent chronic disease, and manage aging process
Nutri-IQ™ is a unique tool that helps Wellness Professionals to easy and conveniently identify clients’ nutritional gaps as possible causes for clients’ complaints.
Interaction of essential nutrients taken with certain medications is discussed below.
Vitamin A
| Medications | Nature of interaction |
| Abciximab, acenocoumarol, ancrod, anisindione, antithrombin III human, argatroban, bivalirudin, clopidogrel, danaparoid, defibrotide, dermatan sulfate, desirudin, dicumarol, eptifibatide, fondaparinux, heparin, lamifiban, pentosan polysulfate sodium, phenindione, phenprocoumon, sibrafiban, tirofiban, warfarin, xemilofiban | Increased risk of bleeding |
| Acitretin, carob, etretinate, isotretinoin, tretinoin, retinoids | Increased risk of vitamin A toxicity |
| Bexarotene | Increased risk of retinoid toxicity |
| Colestipol, orlistat | Decreased vitamin A effectiveness |
| Minocycline | Increased risk of pseudotumor cerebri (benign intracranial hypertension) |
Vitamin B1 (Thiamin)
| Medications | Type of interaction |
| Furosemide | Decrease in thiamin concentrations. |
| Chemotherapy with Fluorouracil | Risk of beriberi or Wernicke’s encephalopathy |
| Nicotine | Flushing and dizziness |
Vitamin B3 (Niacin)
| Medications | Nature of interaction |
| Atorvastatin, cerivastatin, fluvastatin, pravastatin, rosuvastatin, simvastatin | Increased risk of myopathy or rhabdomyolysis |
| Cholestyramine, colestipol | Decreased niacin absorption |
| Nicotine | Flushing and dizziness |
| Isoniazid, pyrazinamide | Decreased niacin status, pellagra |
| Antidiabetes medications: biguanide (metformin), sulfonylureas (glyburide, glimepiride), meglitinides (nateglinide, repaglinide), DPP-4 inhibitors (saxagliptin, sitagliptin), GLP-1 agonists (exenatide, liraglutide, albiglutide), SGLT-2 inhibitors (canagliflozin, dapagliflozin, empagliflozin), alpha-glucosidase inhibitors (acarbose), thiazolidinediones (pioglitazone), amylin analogs (pramlintide) | Decreased effectiveness, increased blood glucose levels |
Pyridoxine (Vitamin B6)
| Medications | Nature of interaction |
| Altretamine | Adversely affects the response duration of altretamine |
| Amiodarone | Enhances amiodarone-induced photosensitivity reactions |
| Contraceptives (combination), cycloserine (Seromycin®), hydralazine, isoniazid, penicillamine | May increase vitamin B6 requirements |
| Fosphenytoin, phenytoin | Reduced phenytoin concentrations |
| Levodopa | Decreased drug effectiveness |
| Valproic acid (Depakene®, Stavzor®), carbamazepine (Carbatrol®, Epitol®, Tegretol®, and others), and phenytoin (Dilantin®); Theophylline (Aquaphyllin®, Elixophyllin®, Theolair®, Truxophyllin®) | Adversely affects B6 status / plasma PLP concentrations |
| Levetiracetam (Keppra®) | Reduce side effects of medication |
Folic Acid (Folate, Vitamin B9)
| Medications | Nature of interaction |
| Colestipol, oristat | Decreased bioavailability of vitamin and mineral preparations possible |
| Fosphenytoin, phenytoin | Increased seizure frequency and decreased phenytoin concentrations |
| Methotrexate (Rheumatrex®, Trexall®) | Folate could interfere with anticancer effects |
| Methotrexate (Rheumatrex®, Trexall®) – low dose | Folate could reduce gastrointestinal side effects |
| Pancreatin, sulfasalazine | Decreased absorption of folate |
| Phenytoin (Dilantin®), carbamazepine (Carbatrol®, Tegretol®, Equetro®, Epitol®), valproate (Depacon®) | Drugs reduce serum folate levels. Folate supplements might reduce serum levels of these medications |
| Pyrimethamine | Pharmacodynamic antagonism of the antiparasitic effect |
| Retinoids | Increased bioavailability of vitamin A and other fat-soluble vitamins |
| Sulfasalazine (Azulfidine®) | Inhibits the intestinal absorption of folate |
| Triamterene | Decreased utilization of dietary folate |
Vitamin B12 (Cobalamin)
| Medications | Nature of interaction |
| Aminosalicylic acid, cimetidine (Tagamet®), famotidine (Pepcid®), and ranitidine (Zantac®). | Reduced vitamin B12 absorption |
| Vitamin C | Reduced amounts of cyanocobalamin available for serum and body stores |
| Chloramphenicol | Decreased hematologic response to cyanocobalamin |
| Colestipol | May decrease the bioavailability of vitamin and mineral preparations |
| Contraceptives (combination) | Decrease in serum vitamin B12 concentrations |
| Proton pump inhibitors, such as omeprazole (Prilosec®) and lansoprazole (Prevacid®) | Decrease absorption of B12 by slowing the release of gastric acid into the stomach |
Biotin
| Medications | Nature of interaction |
| Carbamazepine (Tegretol®, Carbatrol®, Epitol®, Equetro®), primidone (Mysoline®), phenytoin (Dilantin®, Phenytek®), phenobarbital (Luminal®, Solfoton®); as well as combinations of these medications | Increase biotin catabolism, reduce biotin status; inhibit intestinal biotin absorption |
Vitamin C
| Medications | Nature of interaction |
| Aluminum carbonate (basic), aluminum hydroxide, aluminum phosphate, dihydroxyaluminum aminoacetate, dihydroxyaluminum sodium carbonate, magaldrate | Aluminum toxicity (personality changes, seizures, coma) |
| Amygdalin | Increased metabolism of amygdalin, leading to increased cyanide concentrations |
| Chemotherapeutic agents: cyclophosphamide, chlorambucil, carmustine, busulfan, thiotepa, and doxorubicin | Vitamin C might protect tumour cells from the action of radiation therapy and chemotherapeutic agents |
| Cyanocobalamin | Reduced amounts of cyanocobalamin available for serum and body stores |
| Indinavir | Decreased plasma indinavir concentrations |
| Statins (3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors) | May attenuate the increase in high-density lipoprotein levels resulting from combination niacin–simvastatin (Zocor®) therapy |
Vitamin D
| Medications | Nature of interaction |
| Corticosteroid medications (prednisone) | Impair vitamin D metabolism |
| Orlistat (Xenical®, alliTM), cholestyramine (Questran®, LoCholest®, and Prevalite®) | Can reduce the absorption of vitamin D |
| Phenobarbital, phenytoin (Dilantin®) | Increase hepatic inactivation of vitamin D and reduce calcium absorption |
Vitamin E
| Medications | Nature of interaction |
| Anisindione, phenprocoumon | Enhanced response to anticoagulants |
| Cholestyramine | Malabsorption of fat-soluble vitamins, decrease in fat-soluble vitamin absorption |
| Colestipol, orlistat | Decreased vitamin E effectiveness |
| Dicumarol, warfarin (Coumadin®) | Increased risk of bleeding |
| Simvastatin (Zocor®) with niacin and other antioxidants | Rise in high-density lipoprotein (HDL) cholesterol |
| Chemotherapy drugs | Antioxidants might protect tumour cells from the action of radiation therapy and chemotherapeutic agents |
Vitamin K
| Medications | Nature of interaction |
| Antibiotics | Destroy vitamin K-producing bacteria in the gut, potentially decreasing vitamin K status |
| Cefoperazone (Cefobid®) | More pronounced effect of inhibiting the action of vitamin K |
| Cholestyramine (Questran®), colestipol (Colestid®) | Reduce absorption of vitamin K and other fat-soluble vitamins |
| Pau d’arco | Reduced vitamin K effectiveness |
| Orlistat | Can reduce absorption of fat-soluble vitamins, such as vitamin K |
| Warfarin (Coumadin®) and similar anticoagulants | Decreased anticoagulant effectiveness |
Calcium
| Medications | Nature of interaction |
| Alendronate, etidronate, levothyroxine, risedronate, tiludronate, bisphosphonates, fluoroquinolone and tetracycline classes of antibiotics, levothyroxine, phenytoin, tiludronate disodium | Reduced drug absorption |
| Aluminum- and magnesium-containing antacids | Increase urinary calcium excretion |
| Amprenavir, aspirin, atenolol, bisacodyl, bismuth subcitrate, cefpodoxime, proxetil, chlortetracycline, ciprofloxacin, demeclocycline, doxycycline, enoxacin, gemifloxacin, grepafloxacin, hyoscyamine, ibandronate, iron, itraconazole, ketoconazole, levofloxacin, lomefloxacin, methacycline, minocycline, norfloxacin, ofloxacin, oxytetracycline, pefloxacin, rolitetracycline, sparfloxacin, sucralfate, temafloxacin, tetracycline, ticlopidine, trovafloxacin mesylate, zalcitabine | Reduced drug efficacy |
| Atazanavir | Reduced plasma concentration of drug |
| Bemetizide, bendroflumethiazide, benzthiazide, buthiazide, chlorothiazide, chlorthalidone, clopamide, cyclopenthiazide, cyclothiazide, hydrochlorothiazide, hydroflumethiazide, indapamide, methyclothiazide, metolazone, polystyrene sulfonate, polythiazide, quinethazone, trichlormethiazide, xipamide | Milk-alkali syndrome (hypercalcemia, metabolic alkalosis, renal failure) |
| Digitoxin, digoxin | Cardiotoxicity: arrhythmia and cardiovascular collapse |
| Glucocorticoids, such as prednisone | Can cause calcium depletion |
| Guar gum | Delayed calcium absorption |
| Mineral oil and stimulant laxatives | Decreased calcium absorption |
| Potassium phosphate, potassium phosphate (dibasic), potassium phosphate (monobasic), sodium phosphate, sodium phosphate (dibasic), sodium phosphate (monobasic) | Decreased phosphate absorption |
| Thiazide-type diuretics | Increased risks of hypercalcemia and hypercalciuria with calcium carbonate and vitamin D supplements |
| Verapamil | Reversal of hypotensive effects |
Chromium
| Medications | Nature of interaction |
| Antacids, corticosteroids, H2 blockers (such as cimetidine, famotidine, nizatidine, and rantidine), proton-pump inhibitors (such as omeprazole, lansoprazole, rabeprazole, pantoprazole, and esomeprazole) | Alter stomach acidity and may impair chromium absorption or enhance excretion |
| Beta-blockers (such as atenolol or propanolol), corticosteroids, insulin, nicotinic acid, Nonsteroidal anti-inflammatory drugs (NSAIDS), prostaglandin inhibitors (such as ibuprofen, indomethacin, naproxen, piroxicam, and aspirin) | May have their effects enhanced if taken together with chromium or they may increase chromium absorption |
Iodine
| Medications | Nature of interaction |
| Angiotensin-converting enzyme (ACE) inhibitors: benazepril (Lotensin®), lisinopril (Prinivil® and Zestril®), fosinopril (Monopril®), | Taking with potassium iodide can increase the risk of hyperkalemia |
| Methimazole (Tapazole®) | Could cause hypothyroidism if taken high doses of iodine |
| Potassium-sparing diuretics, such as spironolactone (Aldactone®) and amiloride (Midamor®) | Taking with potassium iodide can increase the risk of hyperkalemia |
Iron
| Medications | Nature of interaction |
| Acetohydroxamic acid, cefdinir, cinoxacin, ciprofloxacin, demeclocycline, doxycycline, gatifloxacin, gemifloxacin, grepafloxacin, ibandronate, levodopa (Sinemet® , Stalevo®), levofloxacin, lomefloxacin, methacycline, methyldopa, minocycline, moxifloxacin, mycophenolate mofetil, n orfloxacin, ofloxacin, oxytetracycline, penicillamine, rolitetracycline, temafloxacin, tetracycline, trovafloxacin mesylate | Decreased drug effectiveness |
| Acetohydroxamic acid, aluminum carbonate basic, aluminum hydroxide, aluminum phosphate, calcium, chloramphenicol, cholestyramine, demeclocycline, dihydroxyaluminum aminoacetate, dihydroxyaluminum sodium carbonate, doxycycline, enoxacin, magaldrate, magnesium carbonate, magnesium hydroxide, magnesium oxide, magnesium trisilicate, methacycline, minocycline, oxytetracycline, rolitetracycline, sodium bicarbonate, tetracycline | Decreased iron effectiveness |
| Etidronate, sparfloxacin, trientine, zinc | Reduced drug absorption |
| Gossypol, soy protein, trientine, vanadium, zinc | Reduced iron absorption |
| Esomeprazole, lansoprazole, omeprazole, pantoprazole, rabeprazole | Reduced iron bioavailability |
| Levothyroxine (Levothroid®, Levoxyl®, Synthroid®, Tirosint®, Unithroid®) | Hypothyroidism |
| Levothyroxine (Levothroid®, Levoxyl®, Synthroid®, Tirosint®, Unithroid®) | Iron supplements (taken simultaneously) reduce effacity of medication |
Magnesium
| Medications | Nature of interaction |
| Allopurinol, amprenavir, aspirin, atazanavir, azithromycin, bisacodyl, bismuth, subcitrate, captopril, cefdinir, cefditoren pivoxil, cefpodoxime proxetil, chloroquine, chlorpromazine, chlortetracycline, cimetidine, cinoxacin, ciprofloxacin (Cipro®), demeclocycline (Declomycin®), doxycycline (Vibramycin®), enoxacin, fexofenadine, gabapentin, gatifloxacin, gemifloxacin, grepafloxacin, hyoscyamine, ibandronate, iron, itraconazole, levofloxacin (Levaquin®), levothyroxine, lomefloxacin, minocycline, misoprostol, moxifloxacin, mycophenolate mofetil, nalidixic acid, norfloxacin, ofloxacin, oxytetracycline, pefloxacin, penicillamine, rolitetracycline, rosuvastatin, rufloxacin, sotalol, sparfloxacin, sucralfate, temafloxacin, tetracycline, ticlopidine, tipranavir, trovafloxacin mesylate, zalcitabine | Decreased drug effectiveness |
| Alendronate (Fosamax®), atevirdine, etidronate, mycophenolate sodium, mycophenolic acid, potassium phosphate, risedronate,sodium phosphate, tiludronate | Decreased drug absorption |
| Delavirdine, lansoprazole | Decreased drug bioavailability |
| Calcitriol, doxercalciferol | Hypermagnesemia |
| Atazanavir, clofazimine, digoxin | Decreased plasma drug concentration |
| Amikacin, dibekacin, gentamicin, kanamycin, netilmicin, streptomycin, tobramycin | Neuromuscular weakness |
| Cisatracurium, rapacuronium, succinylcholine, vecuronium | Enhanced neuromuscular blockade |
| Dicumarol | Increased risk of bleeding |
| Didanosine, mefenamic acid, quinidine, rocuronium | Increased risk of adverse drug effects |
| Esomeprazole magnesium (Nexium®), lansoprazole (Prevacid®) taken more than a year | Can cause hypomagnesemia |
| Felodipine, isradipine | Hypotension |
| Furosemide (Lasix®), bumetanide (Bumex®), thiazide, hydrochlorothiazide (Aquazide H®), ethacrynic acid (Edecrin®) | Magnesium depletion |
| Glipizide, glyburide, nicardipine, nifedipine | Hypoglycemia |
| Labetalol | Bradycardia and decreased cardiac output |
| Polystyrene sulfonate | Increased risk of metabolic alkalosis |
| Levomethadyl | Increased risk of QT prolongation |
| Tacrolimus | Increased drug exposure |
Phosphorus
| Medications | Nature of interaction |
| Alcohol | Deplete phosphorus from the body |
| Antacides (Mylanta, Amphojel, Maalox, Riopan, and Alternagel) | Low phosphate status |
| Anticonvulsants (phenobarbital, carbamazepine, Tegretol) | May lower phosphorus levels and increase levels of alkaline phosphatase, an enzyme that helps remove phosphate from the body |
| Benazepril (Lotensin), captopril (Capoten), enalapril (Vasotec), fosinopril (Monopril), lisinopril (Zestril, Prinivil), quinapril (Accupril), or ramipril (Altace); cyclosporine, digoxin, Lanoxin, heparins, ibuprofen, Motrin; salt-substitutes | May decrease phosphorus levels |
| Cholestyramine (Questran), colestipol (Colestid) | Decrease the oral absorption of phosphates from the diet or from supplements |
| Corticosteroids including prednisone (Deltasone) or methylprednisolone (Medrol) | May increase urinary phosphorus levels |
| Diuretics: hydrochlorothiazide (Hydrodiuril) or urosemide (Lasix) | Increase the elimination of phosphorus from the body in the urine causing symptoms of phosphorus deficiency |
| High doses of insulin | Decrease blood levels of phosphorus in people with diabetic ketoacidosis |
| Potassium supplements or potassium-sparing diuretics including spironolactone (Aldactone), triamterene (Dyrenium) | May cause high blood levels of potassium (hyperkalemia) |
Potassium
| Medications | Nature of interaction |
| ACE inhibitors (benazepril or Lotensin®), ARBs (losartan or Cozaar®); potassium-sparing diuretics (amiloride or Midamor®; spironolactone or Aldactone®) | Hyperkalemia due to reduced urinary potassium excretion |
| Loop diuretics (furosemide or Lasix®, bumetanide or Bumex®), thiazide diuretics (chlorothiazide or Diuril®, metolazone or Zaroxolyn®) | Hypokealemia due to increased urinary potassium excretion |
Selenium
| Medications | Nature of interaction |
| Chemotherapy | Selenium could alleviate side effects of chemotherapy |
| Cisplatin (inorganic platinum chemotherapy agent) | Can reduce selenium levels in hair and serum |
Sodium
| Medications | Nature of interaction |
| Lithium | Using with sodium chloride may decrease effects of the medication |
| Tolvaptan | May cause sodium levels to increase too rapidly |
Zinc
| Medications | Nature of interaction |
| Cinoxacin, ciprofloxacin, enoxacin, gatifloxacin, grepafloxacin, levofloxacin, moxifloxacin, norfloxacin, ofloxacin, tetracycline | Decreased drug effectiveness and zinc absorption |
| Thiazide diuretics (chlorthalidone (Hygroton®), hydrochlorothiazide (Esidrix® and HydroDIURIL®) | Deplete zinc tissue levels |
| Gemifloxacin, sparfloxacin | Decreased drug absorption |
| Penicillamine | Decreased zinc absorption |
| Copper | Decreased zinc or copper absorption |
| Iron | Decreased zinc or iron absorption |
Essential Fatty Acids
| Medications | Nature of interaction |
| Atorvastatin (Liptor), lovastatin (Mevacor), simvastatin (Zocor) | Medication works more effectively |
| Cancer therapy (doxorubicin, cisplatin, carboplatin, idarubicin, mitoxantrone, tamoxifen, vincristine, and vinblastine) | GLA may increase the effects of anti-cancer treatments |
| Ceftazidime | Gamma linolenic acid (GLA) may increase the effectiveness of medication |
| Cyclosporine | Taking omega-3 and omega-6 fatty acids during cyclosporine (Sandimmune) therapy may reduce toxic side effects, such as high blood pressure and kidney damage, associated with this medication in transplant patients |
| Etretinate and topical steroids | Addition of omega-3 fatty acids (specifically EPA) to the drug therapy may improve symptoms of psoriasis. |
| Glipizide (Glucotrol and Glucotrol XL), glyburide (Micronase or Diabeta), glucophage (Metformin), or insulin | May increase fasting blood sugar levels |
| Hlorpromazine (Thorazine), fluphenazine (Stelazine), perphenazine (Trilafon), promethazine (Compazine), thioridazine (Mellaril) | Omega-6 from evening primrose oil (EPO) may increase the risk of seizure |
| NSAIDs including ibuprofen (Motrin or Advil) and naproxen (Alleve or Naprosyn). | Reduced the risk of side effects (ulcers) |
| Warfarin (Coumadin®) and similar anticoagulants | Might have antiplatelet effects at high doses, might prolong clotting times. |
References
- Elizabeth A Yetley, Multivitamin and multimineral dietary supplements: definitions, characterization, bioavailability, and drug interactions, The American Journal of Clinical Nutrition, Volume 85, Issue 1, January 2007, Pages 269S–276S, https://doi.org/10.1093/ajcn/85.1.269S
- Elson Haas. “Staying Healthy with Nutrition”
- Merck Manual for the Professional: https://www.merckmanuals.com/en-ca/professional
- Reuters research: https://www.reuters.com/brandfeatures/venture-capital/article?id=104499
- Mordor Intelligence: https://www.mordorintelligence.com/industry-reports/north-america-nutraceutical-market
- PennState Health – Milton S. Hershey medical Center: http://pennstatehershey.adam.com/content.aspx?productId=107&pid=33&gid=000974
- US Department of Health and Human Services, Office of Dietary Supplements: https://ods.od.nih.gov